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Original research
Association of faecal pH with childhood stunting: Results from a cross-sectional study
  1. Md. Shabab Hossain1,
  2. Subhasish Das1,
  3. Md. Amran Gazi1,
  4. Md. Ashraful Alam1,
  5. Nur Muhammad Shahedul Haque1,
  6. Mustafa Mahfuz1,
  7. Tahmeed Ahmed1,
  8. Chris J Damman2,3
  1. 1 Nutrition and Clinical Services Division (NCSD), International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
  2. 2 Division of Gastroenterology, University of Washington, Seattle, Washington, USA
  3. 3 Bill and Melinda Gates Foundation, Seattle, Washington, USA
  1. Correspondence to Dr Tahmeed Ahmed; tahmeed{at}


Background Gut microbiota plays an important role in the growth of children. The gut of children with optimum growth is enriched in certain species, especially Bifidobacteria and Clostridia. Bifidobacteria and commensal Clostridia both contribute to formation of acidic stool, and an elevated faecal pH indicates reduction of these species in the gut. The purpose of the study was to investigate the association of faecal pH with childhood stunting.

Methods In this cross-sectional study, 100 children with length-for-age Z score (LAZ) <−1 aged between 12 and 18 months were enrolled from the ongoing Bangladesh Environmental Enteric Dysfunction study conducted in Dhaka, Bangladesh. LAZ was measured by anthropometry and data on factors affecting linear growth were recorded. Faecal pH measurement was done using pH metre on freshly collected non-diarrhoeal faecal samples following standard procedure. Multiple quantile regression was done to quantify the relation between faecal pH and LAZ scores.

Results The mean LAZ and faecal pH of the children were −2.12±0.80 and 5.84±1.11, respectively. Pearson correlation analysis showed a statistically significant negative correlation between stool pH and the LAZ scores (p<0.01). After inclusion of other factors affecting linear growth into the regression model, a statistically significant inverse association was observed between faecal pH and LAZ score (p<0.01).

Conclusion Elevated faecal pH was found to have a significant association with stunted growth. As an indicator of gut microbiota status, faecal pH might have emerged as a possible indirect determinant of childhood stunting.

Trial registration number NCT02812615

  • Faecal pH
  • growth
  • children
  • Bangladesh

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  • Contributors CJD and TA originated the idea for the study and TA led the protocol design. MSH, SD and TA participated in the design of the study. MSH, SD, MAG, NMSH, MM and TA conducted the study and supervised the sample and data collection. MSH and MAG performed and supervised the sample analysis. MSH, SD, MAA, MM and TA were involved in the data analysis. MSH, SD and TA interpreted the results. MSH, SD, MM and TA were involved in the manuscript writing. All authors read and approved the final manuscript.

  • Funding This protocol is supported by the Bill and Melinda Gates Foundation under its Global Health Program. Project investment ID is OPP1136751. (

  • Competing interests None declared.

  • Patient and public involvement statement This research was done without patient involvement. Patients were not invited to comment on the study design and were not consulted to develop patient relevant outcomes or interpret the results. Patients were not invited to contribute to the writing or editing of this document for readability or accuracy.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was taken from Ethical Review Committee (ERC) of the Institutional Review Board (IRB) of icddr,b.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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